title: Validation of the Multiple Suggested Immobilization Test: A Test for the Assessment of Severity of Restless Legs Syndrome (Willis-Ekbom Disease).
abstract: OBJECTIVE
  To validate the Multiple Suggested Immobilization Test (m-SIT), a symptom-provocation test measuring restless legs syndrome (RLS) severity multiple times a day while the patient is awake and resting under controlled conditions. The m-SIT was designed to overcome some limitations in measuring RLS severity with rating scales.
  
  
  METHODS
  Patients completed two m-SITs on 2 consecutive days while on 24-h dopaminergic medication. After treatment discontinuation, they completed one more m-SIT 3 days later. Controls performed only one m-SIT.
  
  
  METHODS
  Sleep laboratory.
  
  
  METHODS
  Nineteen patients with RLS and 10 healthy controls.
  
  
  METHODS
  The original m-SIT consisted of seven modified 60-min SITs performed every 2 h between noon and midnight. During each SIT, the subject reclined quietly but could move his or her legs without restriction to alleviate symptoms. Every 10 min, periodic leg movements during wakefulness (PLMW) were evaluated and the m-SIT Disturbance Scale (m-SIT-DS; range 0-10) was completed.
  
  
  RESULTS
  The m-SIT, composed of 6:00pm, 8:00pm, 10:00pm, and 12:00pm SITs, discriminated patients from controls (mean m-SIT-DS: 2.68 ± 2.35 versus 0.08 ± 0.26; mean PLMW/h, P = 0.0001) and between treatment groups (on medication versus taken off medication; mean m-SIT-DS, P = 0.0001; mean PLMW/h, P < 0.01). It proved reliable on retest and covariated well with the International Restless Legs Scale (IRLS) and scales measuring daytime symptoms (Spearman ρ > 0.4).
  
  
  CONCLUSIONS
  The m-SIT is a valid and reliable test to evaluate RLS severity and treatment response, and could be useful in the future to confirm diagnosis and identify daytime symptoms. Although it was primarily designed for clinical trials, it might be useful in clinical settings because it provides a standardized testing condition to measure RLS symptoms.
  
  
  BACKGROUND
  Garcia-Borreguero D; Kohnen R; Boothby L; Tzonova D; Larrosa O; Dunkl E. Validation of the Multiple Suggested Immobilization Test: a test for the assessment of severity of restless legs syndrome (Willis-Ekbom disease).SLEEP2013;36(7):1101-1109.
authors.affiliation: Sleep Research Institute, Madrid, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Garcia-Borreguero
authors.forename: Ralf
authors.initials: R
authors.lastname: Kohnen
authors.forename: Lindsay
authors.initials: L
authors.lastname: Boothby
authors.forename: Desislava
authors.initials: D
authors.lastname: Tzonova
authors.forename: Oscar
authors.initials: O
authors.lastname: Larrosa
authors.forename: Elmar
authors.initials: E
authors.lastname: Dunkl
keywords: Daytime symptoms; Willis-Ekbom disease; laboratory tests; restless legs syndrome